Born on the 24th of July 1956 in the USA, Dr. Lisa Sanders is a board-certified internist at Yale-New Haven Hospital and teacher at Yale School of Medicine. Dr. Sanders is the author of the popular New York Times Magazine “Diagnosis” column – the inspiration behind the TV series House, M.D.. Furthermore, she is also the author of the featured title “Think Like a Doctor”, in the New York Times health blog; The Well; and also the best-selling book “Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis”.
Last year, at iMed Conference® 7.0, Dr Lisa Sanders gave the FRONTAL magazine the pleasure of a small conversation on what it means to be a doctor today and about her career.
FRONTAL (F): You are considered a nontraditional doctor because you started out as a journalist. Can you tell us what attracted you in Journalism?
LISA SANDERS (LS): What attracted me in journalism… Gosh, what is not to like. You get to go, you get to travel, you get to ask interesting questions, you get to meet interesting people, you get to learn about something new every day. You know, there is so much about journalism that is wonderful and interesting and glamorous and fun. It is an easy thing to like.
F: Why did you decide to go for Medicine afterwards? What made you change your mind about your career? How did Medicine fascinate you?
LS: Well, you know, the thing about television is that lots of people watch television, but very few people are touched by television. It doesn’t make a difference in people’s lives. So, after I’ve done it for a while, I wanted something else – something a little bit more intimate and more personal, that would allow me to do the difference. And it seems to me that Medicine is the way to do it.
F: But, if you had to choose between writing and Medicine, which one would you go for?
LS: That would never be a choice! Medicine is all about telling stories. Writing is all about telling stories. It is the same activity – just within a different media.
F: You later pursued Internal Medicine. What was the appeal in this specialty? Why choosing this field?
LS: I am not interested in a part of the person – I am interested in the person – and that includes their hearth, and their lungs, and their kidneys, and their liver, and their GI tract. And only Internal Medicine would let me be part of all of that. And, more importantly, if you couldn’t make a diagnosis, you have to look at the whole person. Not always, but sometimes you can look at just that one thing and find the answer. But often enough, you need to think in the whole person in order to make a diagnosis.
F: You have also published several books. Can you tell us how you first book on diet came about?
LS: Completely by accident, like so many things in life. I wanted to work with this one researcher, and she was going to do some research on…. I can’t even remember what it was. So I read up that thing and then I went to see her. We were interested in low carbs diet and we were going to compare low carbs diets to low calories diets or low fat diets, and to see what works better. And I am like: “Oh, not very interested in weight loss”. I think it never works. And she said: “Well, that’s ok, but that is what we are doing.” So that’s what we did. And so when I was reading this old study, I saw that, no matter how foolish the diet, no matter how ridiculous the intervention was, some small portion, 10%, 20% or 30% of the people that participated, actually lost weight. While 10%, 15% or 20% actually gained weight. So I thought: what is the difference between those three groups? And I thought that this is about whether you could stick to the diet. If you hate vegetables, then putting yourself on a low fat diet means that you are just going to suffer and to be unhappy, and you won’t stick to it. You are going to eat whatever you want anyway because you can’t eat the things that are on your diet. So, that was where that came from. And it also came from the sense that you have to treat the whole person. You can´t just treat their pants size – you have to treat the whole person and to take into consideration all of their things. A lot of times people go on low fat diets when they couldn’t eat on a regular basis. Now, the thing about low fat diets is that you have to eat a lot or frequently because you’re eating foods that don’t stick around. If you can’t eat every few hours, well, you’re going to be miserable. So, I am trying to figure out what works for the whole person.
F: Was House [from House MD] inspired by a real person? Do you consider him to be a “different doctor” with a very peculiar personality? How did you come up with the idea of a grumpy yet genius doctor?
LS: I didn’t came up with that idea – I wish I did. [laughs] I came up with the idea that making a diagnosis was like a mystery, like you could approach a person with a disease the way you could approach a murder mystery, except that, God willing, the patient lives. And so that was what I wrote in my calm little detective stories, where there are doctors and patients figuring out the disease. It was David Shore, who was the executive producer, that came out with the idea of House as a cranky guy. He said that he once went to a doctor. He hurt his hip while he was running, and made an appointment to see an orthopedic surgeon. By the time he got to see the orthopedic surgeon of course his hip was fine, but he went anyway. And, while he was there, he felt like an idiot because, according to him “the doctor would say ‘show me where it hurts now’, and I would say that it didn’t hurt anymore. And then the doctor said: ‘Ok, come back when it hurts.’ And I thought that when I leave the room, they would laugh at me, because I was an idiot. I want a doctor who does laugh at my face.” So, that’s House.
F: Do you have any advices for the future of our medical students?
LS: When you think about what you want to do in Medicine, you must think about your daily life. And do not think about prestige, or money, or your free time. Maybe free time, a little bit, but prestige and money… They don’t actually make you happy. There have been studies made on how much money you have to make before more money does make a difference. And this is an incredibly small amount. There is no doctor that makes less than this. So, money doesn’t really matter. What really matters is that, every day, you go to work and you will be doing something that you really, really like. Something that when you wake up in the morning makes you think “Oh good, I need to go to work!”, instead of “Oh God… I have to go to work…”. It’s not by accident that doctors have the highest rates of suicide and the highest rates of drug abuse, at least in the USA. We are at the top of everybody’s most miserable professionals list. And that is only because we get caught up in money prestige and other things besides why I am loving what I am doing right now. Because it is too hard a job that takes to much out of you to do something you’re not excited about, not deriving pleasure from or not deriving satisfaction from. Those other kinds of satisfaction are very transient, as many doctors have found out. In the long run, doing what you want to do, doing what gives you pleasure, doing what interests you – those are the things that are going to get you through your whole career. If you are not interested, if you are not pleased, you are going to be unhappy… Or out of a job.